How to Quit Smoking

       So you’ve decided to become a former smoker? Congratulations! Nearly four out of five smokers want to quit, and each year 40 percent of smokers finally attempt it. Before you start, it is important to remember this; research shows that the most success comes to smokers who use more than one method to fight their cravings and withdrawals. Despite your best efforts, you may not succeed the first time. But because you have already committed yourself to quitting, you are one step closer to being a former smoker.
      Start by researching all your options to find the best quit-smoking strategy for you. You might want to do this in collaboration with your doctor or another healthcare professional because the right thing for you may require a prescription. It is also wise to have a doctor involved so that he or she can monitor you for any side effects or possible complications. Here are some of the more common and proven treatment options and why they may be right for you.

Nicotine-Replacement Patch
Nicotine patches are available over the counter and are generally easy to use.

How does it work?
The patch is designed to release a steady dose of nicotine throughout the day. As cravings and withdrawal symptoms decrease, you can begin to reduce the length of time you wear a patch or switch to a patch with lower dosage strength. However, if you have sudden cravings or severe symptoms of withdrawal, you may be left unable to quickly satiate them; the patches aren’t designed for an instantaneous shot of nicotine, and you cannot smoke while using the patch or you risk nicotine overdose that can cause heart attack and paralysis

Who should use the patch?
Many people trying to quit can benefit from using the patch. It is simple to use and easy to apply. Most nicotine replacement patches have been designed to wean users off very carefully through controlled dosages. But because you won’t be able to handle intense cravings or symptoms of withdrawal, it might not be the best option to try first. Many people try other aids at first so they can control symptoms more immediately.

Nicotine Gum
Nicotine gums are available over the counter, and they work for a great number of people who are trying to quit. But this is no typical chewing gum.

How does it work?
Nicotine gums must be used in a specified manner in order for them to work properly. (Instead of chewing endlessly, the gum is chewed for a few minutes and then placed between your gum and inner cheek where it stays for about 30 minutes.) You don’t get an endless supply of chewing gum either. Instead, you follow a schedule of one piece every one to two hours. As your cravings subside and the withdrawal symptoms become more manageable, you can reduce the dosage in the gum or chew less often.

Who should use gum?
People may choose the nicotine chewing gum because they need to satisfy an oral activity craving, something an actual cigarette fulfilled previously. Unlike the patch, the gum can provide a quick boost of nicotine in the event of severe cravings or withdrawal symptoms. However, if you follow the schedule, this shouldn’t be a problem. If you have a hard time keeping track of a schedule or don’t think you would be able to chew gum on a regular basis (because of work or social commitments), this may not be the best aid for you.

Nicotine Inhaler
The goal of all nicotine-replacement therapies is to provide the body with as pure a form of nicotine as possible and without all the carcinogenic additives found in cigarettes. Many smokers crave the feeling of having smoke in their mouths—something neither patches nor chewing gum can provide. Enter nicotine inhalers.

How does it work?
These prescription devices work by vaporizing liquid nicotine for you to inhale. The nicotine is then absorbed in the mouth and throat and delivers a quick nicotine boost. As the body grows accustomed to less and less nicotine, you will gradually stop using the inhaler until you’ve fully quit.

Who should use inhalers?
You may be giving yourself an inhalation treatment six to 16 times a day when you start. If taking the time out of your schedule to provide this treatment will complicate work or social schedules, the inhaler may not be for you. The use of inhalers is also limited due to possible complications and side effects in sensitive groups—the elderly, women who are pregnant or may become pregnant, as well as women who are nursing.

Nicotine Nasal Spray
Similar to how the nicotine inhaler supplies pure nicotine through the mouth and esophagus, nicotine nasal spray delivers through the nose.

How does it work?
Nasal sprays use a liquid-to-spray route to make absorbing the nicotine easier. Your doctor will set up the best dosage plan for you; most suggest one to two doses per hour. As your cravings decrease, you will work with your doctor to reduce the number of doses each day until you no longer need the spray entirely.

Who should use sprays?
As with the inhaler, sprays require frequent treatment, and unlike chewing gums, this treatment is less than discrete. If you will not be able to maintain the schedule for work or social reasons, a spray may not be the best aid for you. If you also have complications inhaling medicine through your nose, nasal spray might not be pleasant or effective for you.

Electronic Cigarette
Electronic cigarettes, also known as e-cigarettes, are battery-operated devices shaped like a traditional cigarette.

How does it work?
Users inhale from e-cigarettes the same way they would traditional cigarettes, but instead of inhaling nicotine mixed with other potentially dangerous chemicals, the e-cigarette turns a purer form of liquid nicotine into a vapor. Some people believe e-cigarettes are safer than traditional cigarettes and prefer to smoke them; others use e-cigarettes as a nicotine-replacement therapy to quit.

Who should use e-cigarettes?
E-cigarette makers claim their products are safer than traditional cigarettes, but the Food and Drug Administration (FDA) does not recommend these devices because they have not been evaluated for safety. (Some individual analyses have shown the vapor to be toxic and possibly contain carcinogens.) Until more is known about e-cigarettes, this may not be a safe alternative for people looking to quit.

Prescription Medicine
A couple of drugs have been approved by the FDA for smoking cessation. They do not contain nicotine, so it is recommended that they be used in conjunction with nicotine-replacement therapy.

How does it work?
Unlike nicotine-replacement therapies, prescription medicines like bupropion SR (Zyban, Wellbutrin) or varenicline (Chantix) do not provide your body with nicotine. Instead, they reduce cravings and lessen withdrawal symptoms by altering chemicals and nicotine receptors in your brain. Both medicines require doctor supervision and prescription—many insurance companies pay for prescription smoking-cessation aids. The FDA also requires that both medicines carry a black box warning; that’s the strongest safety warning the FDA can issue about a prescription medication. The reasons for these warnings: Bupropion may cause suicidal thoughts or behaviors, depression, and hostility. Patients taking varenicline report increased risk of falls and road accidents, as well as vision troubles and vivid or unusual dreams.

Who should use prescription medicines?
Unlike with nicotine-replacement therapies, neither of these drugs contains nicotine, so the risk of nicotine overdose is small. For that reason, you may still be able to smoke the first few weeks of using these drugs (unless you are also using a nicotine-replacement therapy at the same time). That is a plus for many smokers who are trying to quit.

Alternative Therapies
Research does not always support alternative therapies with hard evidence, but many former smokers who have used these techniques swear by them. In your quest to quit, you may find one or more of these helpful. While nicotine-replacement therapies or prescription medications can subdue your cravings and whittle away at your withdrawal symptoms, you may find you are still battling the desire to smoke.

How do they work?
Hypnotherapy or hypnosis can help identify unconscious triggers—things that make your body crave a cigarette without your understanding the underlying reason, like a time of day or a certain odor. The therapist may then try to replace your unhealthy cigarette-smoking response to these triggers with something more healthful. Acupuncture—a therapy in which tiny needles are used to stimulate certain points on the body—may help reduce nicotine cravings and ease withdrawal symptoms. Meditation can help you relax and ease anxiety. Quitting smoking can be stressful and frustrating, and meditation may help you ease the angst you experience.

Who should use alternative therapies?
Most of these can be used in conjunction with other therapies. In fact many doctors and therapists will recommend a multidimensional approach to beating your addiction.

Group or Individual Counseling
The use of medication (nicotine-replacement therapies included) more than doubles your likelihood for success. But study after study also shows the importance of therapy and counseling when fighting an addiction.

How does it work?
Counseling provides you the opportunity to ask questions, learn from others’ experiences, and prepare for the next stage of your journey.

Who should use counseling?
Almost everyone can benefit from some type of counseling or support when trying to quit smoking. Whether it is one-on-one with a therapist or in a group setting with fellow future nonsmokers, it is important to talk to others about what you are experiencing and ask for the additional accountability you will need to see your journey through to the end.

Refer: By the Healthline Editorial Team
Reviewed by Jennifer Monti, MD, MPH